Steven Wheeler, PhD, OTR/L, FAOTA, CBIS, is Professor and Chair of Occupational Therapy, Division of Occupational Therapy, West Virginia University, Morgantown;
Amanda Acord-Vira, EdD, OTR/L, FAOTA, CBIS, is Associate Professor of Occupational Therapy, Division of Occupational Therapy, West Virginia University, Morgantown.
Am J Occup Ther. 2023 Jul 1;77(4). doi: 10.5014/ajot.2023.077401.
Occupational therapy practitioners are uniquely qualified to address the occupational needs of people with traumatic brain injury (TBI) and their caregivers to maximize participation, health, and well-being.
These Practice Guidelines are informed by systematic reviews of the effectiveness of interventions that address impairments and skills to improve the occupational performance of people with TBI, as well as interventions for caregivers of people with TBI. The purpose of these guidelines is to summarize the current evidence available to assist clinicians' clinical decision-making in providing interventions for people with TBI and their caregivers.
We reviewed six systematic reviews and synthesized the results into clinical recommendations to be used in occupational therapy clinical practice.
Sixty-two articles served as the basis for the clinical recommendations.
Strong to moderate evidence supports multimodal sensory stimulation, unimodal auditory stimulation, physical activity, virtual reality, cognitive interventions, vision therapy, goal-focused interventions, individual and group training and education, and caregiver supports. Occupational therapy practitioners should incorporate these interventions into individual and group sessions to maximize recovery and promote occupational participation. Additional interventions are also available, based on emerging evidence and expert opinion, including prevention approaches, complexity of injury, and the use of occupation-based performance assessments. What This Article Adds: These Practice Guidelines provide a summary of evidence in clinical recommendations tables supporting occupational therapy interventions that address impairments resulting from and skills to improve occupational performance after TBI. The guidelines also include case study examples and evidence graphics for practitioners to use to support clinical reasoning when selecting interventions that address the goals of the person with TBI and their caregiver's needs.
职业治疗师具备独特的资格，可以满足创伤性脑损伤（TBI）患者及其照顾者的职业需求，以最大限度地提高参与度、健康和幸福感。
这些实践指南是通过对干预措施的有效性进行系统评价得出的，这些干预措施旨在解决影响 TBI 患者职业表现的损伤和技能问题，并为 TBI 患者的照顾者提供干预措施。这些指南的目的是总结目前可用的证据，以协助临床医生在为 TBI 患者及其照顾者提供干预措施时做出临床决策。
我们回顾了六项系统评价，并将结果综合为临床建议，用于职业治疗临床实践。
62 篇文章为临床建议提供了依据。
有力到中等强度的证据支持多模式感觉刺激、单模式听觉刺激、身体活动、虚拟现实、认知干预、视觉疗法、以目标为导向的干预、个体和小组培训和教育以及照顾者支持。职业治疗师应将这些干预措施纳入个体和小组治疗中，以最大限度地促进康复和职业参与。此外，还根据新出现的证据和专家意见提供了其他干预措施，包括预防方法、损伤的复杂性以及基于作业的表现评估的使用。本文的新增内容：这些实践指南提供了一份总结，列出了支持职业治疗干预的证据，这些干预措施旨在解决 TBI 后的损伤和技能问题，以提高职业表现。指南还包括案例研究示例和证据图表，供从业者在选择针对 TBI 患者及其照顾者需求的干预措施时支持临床推理。
